How to manage persistent depression

People with persistent depressive disorder (PDD) – also known as dysthymia – experience long-term, ‘milder’ depressive symptoms compared to people diagnosed with major depressive disorder.

Although symptoms of persistent depressive disorder are considered to be less severe than those experiencing a major depressive episode, this condition can still have a serious impact on day-to-day functioning. Speak to a health professional if you’re worried you could be experiencing dysthymia.

Signs and symptoms of dysthymia

Dysthymia is a chronic mood disorder that can affect thoughts, feelings, and behaviors. Symptoms are persistent and last for years. Symptoms typically involve feeling apathetic or indifferent towards things previously enjoyed. To be diagnosed, symptoms of PDD need to have continued for two years or more in adults, or over a year in children and adolescents. ^{[1] [2]}

People who experience dysthymia are more likely than the general population to also experience other mental health problems. Only about 25-30% of cases occur over a lifetime without any other psychiatric disorders. ^[3] Symptoms of PDD can also occur alongside symptoms of major depressive disorder – also known as ‘double depression’.

There is some overlap between the symptoms of dysthymia and major depressive disorder making the two conditions difficult to distinguish. Always speak to a healthcare professional rather than attempting to self-diagnose. ^[2]

Behavioral symptoms include:

• Changes to eating – over-eating or under-eating
• Changes to sleeping – getting too much or too little sleep
• Difficulty concentrating
• Decreased productivity
• Lack of energy
• Withdrawing from friends or avoiding social activities

Emotional symptoms include:

• Low self-esteem or worthlessness
• Feeling sad, empty, hopeless,or down
• Feeling guilty or worrying excessively about things
• Apathy or indifference towards others or daily activities you used to enjoy
• Irritability and anger

Coping with dysthymia

As with major depressive disorder, people with dysthymia are most likely to benefit from a combination of treatments, including psychiatric medication, talking therapy, and managing symptoms with self-care techniques. Self-care can include regular physical activity and eating a nutritious diet.

Treatments for PDD include:

• Antidepressants. The same drugs prescribed to people experiencing major depressive disorder can also be offered to those experiencing symptoms of persistent depression. A particular group of psychiatric drugs called selective serotonin reuptake inhibitors (SSRIs) are thought to be effective in treating dysthymia by changing the way certain neurotransmitters are absorbed in the brain, in turn improving mood. ^[3] Before prescribing anti-depressants, and when deciding whether they are right for you, your healthcare professional should make you aware of, and talk you through, any potential adverse side effects. ^[4]
• Talking therapy. Many different types of therapy – including cognitive behavioral therapy (CBT), psychodynamic, insight-oriented, and interpersonal psychotherapy – can benefit people experiencing PDD. ^[2]
• Lifestyle changes and self-care. People with all types of depression and anxiety disorders can see an improvement in their symptoms by engaging inregular physical exercise, especially outdoors. Outdoor activities, such as gardening and conservation efforts, have been shown to alleviate symptoms of depression. ^[5] In addition, eating a healthy diet with plenty of fruit and vegetables and lowering consumption of sugar, caffeine, and alcohol have also been shown to help support good mental health. ^[6]
• Mindful activities – which help us focus our attention on the present moment – such as yoga, meditation,and art therapy – can ease symptoms of common mental health problems. ^[7]
• Loneliness and lack of meaningful social interactions are linked to poorermental health. Loneliness can worsen our mental health, increasing our risk for depression and anxiety. In addition, having a diagnosis of depression or anxiety can cause us to withdraw from social activities or push our friends away, increasing feelings of loneliness. ^[8] Peer support is a therapeutic activity where you can share problems and experiences with others in similar situations. ^[9]

Seeking help for persistent depression

As with all mental health problems, the sooner you ask for help, the better. Symptoms left untreated can worsen. If you’re worried about your mental health, consider speaking to someone you trust. Talking to a friend can be a good way to offload and get some social support. However, only a healthcare professional will be able to guide through treatment recommendations.  

Mental, just like physical, health can fluctuate throughout our lives. We’re more likely to see our moods worsen during challenging life events such as bereavement, loss of a job, or relationship breakdown.

But if you’ve noticed changes to your thoughts, feelings, and behaviors that last longer than two weeks, keep returning, and have a significant impact on your daily life and functioning, it’s best to speak to a healthcare expert. Treatment is available and recovery is possible.